A GUIDE TO REFFERAL FOR GBV SURVIVORS

STANDARD OPERATIONAL PROCEDURES

Yemen mission

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 TABLE OF CONTENT

INTRODUCTION 3

PART 1: TERMS AND STANDARDS OF PRACTICE 4-8

SECTION 1: Key definitions

.
SECTION 2: Impact of GBV

SECTION 3: Survivor centered approach

SECTION 4: A multi-sectoral approach for GBV survivors

PART 2: INDENTIFICATION OF GBV SURVIVORS 8-9

SECTION 5: Signs of violence

SECTION 6: Look & listen

PART 3: HOW TO APPLY THE REFERRAL PROCESS 8-9

SECTION :7 The referral process

SECTION 8: Documentation, monitoring and recording referral

SECTION 9: Financial support to access services

PART 4: IMPLEMENTATION AND REVIEW OF SOP 8-9

SECTION 10:

SECTION 11:

ANNEX I: Referral form

ANNEX II: Follow-up to referral
ANNEX III: Tips on follow-on with GBV survivors by phone
ANNEX IV: Transportation support
=

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Gender-Based Violence (GBV herein after) is a human rights violation as well as a public health issue, mostly affecting
women and girls around the world. According to the 2021 Yemen HNO 15,765.420 people in need for protection with
14,044,344 were in severity 3,4 and 5 transited to 45% of women and 54% girls with this category are at risk of different
forms of GBV, with 77 per cent of GBV incidents linked to domestic violence, which has increased during COVID-19 1. Loss
of sources of income or livelihood opportunities, confinement within the household, and increased stress and anxiety
are some of the key prevalent causes of the reported increase in GBV. Women and girls, in particular female-headed
households and those perceived to be affiliated with extremist groups are at heightened risk of GBV.

The Yeman health system does not have the capacity yet to offer proper GBV services to meet the needs of survivors.
Stigmatization and fear of retaliation in addition to a shortage of trained health professionals prevents victims from
seeking assistance. The GBV databased coordinated by GBV-Sub cluster has identified centres providing psychosocial
support and referral to health care as the most common route for victims of GBV.

Referral mechanisms with other sectors through the multi sectoral referral pathways for timely and comprehensive
service delivery is key good practice as per IASC GBV guiding principles. The same international guidelines emphasis the
critical role of non-GBV sectors in collectively addressing GBV as part of shared responsibilities to prevent and respond
to human rights violation. Capacity development of non GBV specialized actors like health staff working in PHCC on GBV
guiding principles may enhance utilization of the services by survivors

Purpose
The following guide is a technical document that aims to support health care provider in offering referral to GBV
survivors visiting health facilities. With a referral system GBV survivor will receive prompt and principled response from
service providers, as first point of contact and onwards. It is an agreement of cooperation among MdM Yemen
(International Non-local Organization-YWU). Refer to Annex I

The referral process is based on international and national standards of the multi-sector approach to assistance that
includes health services, psychosocial support, protective care, and legal services (legal advice, representation,
mediation and litigation), livelihood/economic assistance, and emergency basic need. Standards of practice that
prescribe and require confidentiality, limited information sharing and recording of sensitive information will be upheld
to avoiding further harm and/or risks to the well-being and safety of the survivors. Provisions for individuals under 18
years of age will be included as to enforce the necessary additional protective measures children are entitled to.

Structure
The following document is structure in two (2) parts. The first section offers definitions and national and international
standards of practice on gender-based programming. The second section provides operational guidance to support
health partitioners in applying referral. It covers pathway, procedures, monitoring of referral and clarifies roles and
responsibilities of actors. Additional supporting and operational documents can be found in the annexes.

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Gender Based Violence Yemen Database (Information Management System).
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 PART I
TERMS AND STANDARDS OF PRACTICE

SECTION 1 Key definitions

What is gender-based violence

An umbrella term for any harmful act that is perpetrated against a person’s will and that is based on socially ascribed
(gender) differences between males and females. It includes acts that inflict physical, sexual or mental harm or suffering,
threats of such acts, coercion, and other deprivations of liberty. These acts can occur in public or in private 2.

The term gender-based violence is most commonly used to underscore how systemic inequality between males and
females—which exists in every society in the world—acts as a unifying and foundational characteristic of most forms of
violence perpetrated against women and girls. It is important to note, however, that men and boys may also be
survivors of GBV, and as with violence against women and girls, this violence is often under-reported due to issues of
stigma for the survivor.

GBV is a violation of universal human rights protected by international human rights conventions, including the right to
security of person; the right to the highest attainable standard of physical and mental health; the right to freedom from
torture or cruel, inhuman, or degrading treatment; and the right to life.

Gender-based violence terminology3

Child Marriage: A formal marriage or informal union before age 18. Child marriage is a reality for both boys and girls,
although girls are disproportionately the most affected. It is widespread and can lead to a lifetime of disadvantage and
deprivation. Child marriage is a form of forced marriage.

Child Sexual Abuse: Refers to any sexual activity between a child and closely related family member (incest) or between
a child and an adult or older child from outside the family. It involves either explicit force or coercion or, in cases where
consent cannot be given by the survivor because of his or her young age, implied force.

Domestic violence: Used to describe violence that takes place within the home or family between intimate partners as
well as between other family members.

Economic abuse: money withheld by an intimate partner or family member, household resources (to the detriment of
the family’s well-being) prevented by one’s intimate partner to pursue livelihood activities, a widow prevented from
accessing an inheritance. This category does not include people suffering from general poverty.

Harmful traditional practice: is defined by the local social, cultural and religious values where the incident takes place.
For example, “booking” girls for marriage but never marrying her, honor killing, female genital
mutilation/cutting/circumcision, polygamy, forced marriage to settle a debt, forced marriage to perpetrator, forced
marriage to settle a dispute, forced marriage because of killing, marriage exchange of women, forced marriage for
financial reasons.

Intimate partner violence: Occurs between intimate partners (married, cohabiting, boyfriend/girlfriend or other close
relationships), and is behavior by an intimate partner or ex-partner that causes physical, sexual or psychological harm,
including physical aggression, sexual coercion, psychological abuse and controlling behaviors, as well as denial of
resources, opportunities or services

2
Guidelines for Integrating Gender-Based Violence Interventions in Humanitarian Action, IASC, 2015
3
Standard operating procedures for prevention of and response to gender-based violence,
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Sexual exploitation: The term ‘sexual exploitation’ means any actual or attempted abuse of a position of vulnerability,
differential power or trust for sexual purposes, including, but not limited to, profiting monetarily, socially or politically
from the sexual exploitation of another. Some types of forced and/or coerced prostitution can fall under this category

Sexual harassment: Unwelcome sexual advances, requests for sexual favors, and other verbal or physical conduct of a
sexual nature.

Types of GBV as per GBVIMS

The GBVIMS was created to harmonize data collection on GBV in
humanitarian settings, to provide a simple system for GBV project
managers to collect, store and analyze their data, and to enable the safe
and ethical sharing of reported GBV incident data. The intention of the
GBVIMS is both to assist service providers to better understand the GBV
cases being reported as well as to enable actors to share data internally
across project sites and externally with agencies for broader trends
analysis and improved GBV coordination.
i. Rape: Non-consensual penetration (however slight) of the vagina, anus
or mouth with a penis or other body part. Also includes penetration of the
vagina or anus with an object.
ii. Sexual Assault: Any form of non-consensual sexual contact that does
not result in or include penetration. Examples include: attempted rape, as
well as unwanted kissing, fondling, or touching of genitalia and buttocks.
Female Genital Mutilation (FGM) is an act of violence that impacts sexual
organs, and as such should be classified as sexual assault. This incident
type does not include rape, i.e., where penetration has occurred.
iii. Physical Assault: An act of physical violence that is not sexual in nature.
Examples include: hitting, slapping, choking, cutting, shoving, burning,
shooting or use of any weapons, acid attacks or any other act that results
in pain, discomfort or injury. This incident type does not include FGM.
iv. Forced Marriage: The marriage of an individual against her or his will. It
occurs without the expressed consent of either one or both of the parties.
v. Denial of Resources, Opportunities or Services: Denial of rightful access
to economic resources/assets or livelihood opportunities, documentation,
restriction on movement education, health or other social services.
Examples include a widow prevented from receiving an inheritance,
earnings forcibly taken by an intimate partner or family member, a woman
prevented from using contraceptives, a girl prevented from attending
school, and information about her rights generally. This does not include
reports of general poverty.
vi. Psychological/Emotional Abuse: Infliction of mental or emotional pain
or injury. Examples include: threats of physical or sexual violence,
intimidation, humiliation, forced isolation, stalking, verbal harassment,
unwanted attention, remarks, gestures or written words of a sexual and/or
menacing nature, destruction of cherished things, etc.

SECTION 2 Impact of GBV on survivors

GBV seriously impacts survivors’ immediate sexual, physical and psychological health, and contributes to greater risk of
future health problems. Possible sexual health effects include unwanted pregnancies, complications from unsafe
abortions, female reproductive disorder or male impotence, and sexually transmitted infections, including HIV. Possible
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physical health effects of GBV include injuries that can cause both acute and chronic illness, impacting neurological,
gastrointestinal, muscular, urinary, and reproductive systems. These effects can render the survivor unable to complete
otherwise manageable physical and mental activities. Possible mental health problems include depression, anxiety,
harmful alcohol and drug use, post-traumatic stress disorder and suicidality.

Survivors of GBV may suffer further because of the stigma associated with GBV. Community and family ostracism may
place them at greater social and economic disadvantage. The physical and psychological consequences of GBV can
inhibit a survivor’s functioning and well-being—not only personally but in relationships with family members. The impact
can further extend to relationships in the community, such as the relationship between the survivor’s family and
the community, or the community’s attitudes towards children born as a result of rape. Some male victims may suffer in
silence for a long time to avoid facing the risk of being persecuted, assaulted or even murdered 4.

SECTION 3 Survivor centered approach

Safety, confidentiality, and respect of survivors’ decisions are the foundational principles of a survivor centered
approach. They are at the core of every action when working with GBV survivors and are always to be respected.

Safety,
‘Safety’ refers to both physical safety and security, as well as to a sense of psychological and emotional safety for people
who are highly distressed. It is important to consider the safety and security needs of each survivor, her family members
and those providing care and support. In the cases of conflict-related and politically motivated violence and domestics
violence, the security risks may be even greater than usual. Individuals who disclose GBV may be at high risk of further
violence, sexual or otherwise, from perpetrators, people protecting perpetrators, and members of their own family due
to notions of family ‘honor’.

Confidentiality
Confidentiality refers to the right of a person to have any information about them treated with respect in that it
promotes safety, trust and empowerment. Confidentiality reflects the belief that people have the right to choose to
whom they will, or will not, tell their story. Maintaining confidentiality means not disclosing any information at any time
to any party without the informed consent of the person concerned. Breaching confidentiality can put the survivor and
others at risk of further harm. If service providers don’t respect confidentiality, other survivors will be discouraged from
coming forward for help. In GBV case management, confidentiality is maintained through strict information sharing
protocols that rest on principles of sharing only what is absolutely necessary to those involved in the survivor’s care with
the survivor’s permission. It is also necessary to protect written data about a survivor or a case through safe data
collection and storage practices.,

Respect & non-discrimination.

All people have the right to the best possible assistance without unfair discrimination on the basis of gender, age,
disability, race, color, language, religious or political beliefs, sexual orientation or social status.

It is important to remember that the guiding principles are interrelated and mutually reinforcing. For example,
confidentiality is essential to promote safety and the right to self-determination and dignity.

Additionally, a survivor centered approached is based on the idea of maintaining decision-making power and autonomy
of GBV survivors that translates into an empowering healing process that includes but is not limited to:
 This approach rooted in the notion of empowerment that looks to channel and put personal power back into the
hands of the individual.
 Interacting with survivors in a way which always recognizes and prioritizes their needs, wishes, rights, equality
and diversity.
4
There was no law specifically prohibiting consensual same-sex sexual activity, although the penal law prohibits sodomy, irrespective of gender. Homosexuality is
thus not illegal/recognized per se in Yemen/ However there have been no reliable reports of extra judicial persecution, assault, and murder of gay men in Yemen .
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  Helps survivors gain more confidence and assurance, which will help them as a first steps to healing and
recovery.
 With increased self-confidence and assurance, survivor will re-gain/develop ability to identify, express needs and
wishes.
 Survivor’s capacity to make decisions about possible interventions will be reinforced. Supporting GBV survivors
in establishing safety action plans in partnership with available resources and community resources
 An approach that focuses on survivor strength

SECTION 4: Multi-sector approach to GBV assistance programs.

Medical/health care- MdM Focused : Medical Interventions to address physical and reproductive health consequences
and injuries resulting from GBV incidents is critical, in particular for the clinical Management of Rape (CMR), ideally
conducted within 72hrs of incident. This can also include initial examination and treatment, follow-up medical care,
mental health care, and health-related legal services, such as preparation of documentation and provision of evidence
during judicial and related processes. Iraqi protocol on CMR require that only certified physicians carry out CMR and
collect evidence.

Specialized mental health services Psychological counselling (done by psychologists) can help survivors cope with the
emotional and behavioral impacts of abuse and violence. In some cases, survivors may face mild or severe mental health
symptoms, and be referred to clinical treatment by psychiatrists and/or general physicians. This response requires
specialized services delivered by qualified mental health professionals

Psychosocial Support are services or support to GBV survivors to recover from emotional, psychosocial and social effects
of GBV including not limited to crisis care, longer term emotional and practical support and information. This includes
psychological counselling from trained persons or professional to overcome stress, trauma and depression.

Legal assistance services: Provision of Legal Assistance services that can promote or help survivors to know their rights,
claim their legal rights and make informed decisions with respect to seeking justice.

Safe Shelter: Safe houses/shelters are

places that provide immediate security,
temporary refuge, and support to
survivors and their families in imminent Economic livelihood support
danger who are escaping violent or
abusive situations or are at risk of further
Emergency Support
violence and who wish to be protected Medical care
through safe shelters, police or
community security and relocation. This
Shelter should be staffed by
professionals and their location should
be confidential (referral to shelter by
case manager only)
GBV SURVIVOR
Safe shelter
Economic empowerment/livelihood Mental health care
services: Skill Development, capacity
building or provision of cash, resources
to enable survivors and vulnerable
persons to gain knowledge and skills to
seek employment or begin an activity Legal aid
that will provide them with income and
Psycho social support
empowered them. These activities aim at

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reinforcing survivors and vulnerable persons’ access to resources and economic opportunities to reduce their
dependence for their basic needs, protect their dignity, and reduce risks of exploitation.

Emergency Basic need support: include provision of any food or nonfood items (NFIs) including dignity kits, starter kits,
and the provision of cash for basic needs to help restore survivors’ dignity.

PART II
HOW TO IDENTIFY GBV SURVIVORS

SECTION 5: Signs of GBV

In Yemen context it may be incredibly difficult for individual to share they have experienced domestic violence, sexual
abuse and/or other forms of GBV. Looking for signs/symptoms can help identify those to whom you can offer
information about services. If these signs can apply to all potential GBV survivor, each situation is different and may vary
based on gender and age. The following signs could evoke that a person is experiencing violence.

 Hematomas, wounds, fractures, dislocations

 Repeated or / and unexplained injuries,
 Unexplained chronic pain, as not medical personnel you might not directly assess these
kinds of disease, injuries and pain, but the patient might disclose about this issue while
talking with you also about other subjects
 Pregnant women: unwanted pregnancies, miscarriage, unsafe abortion. This
Physical signs information might be disclosed by the survivor. Sometimes, especially after a trauma as
a GBV, beneficiaries could start to talk about details of the violence they endured and
the physical consequences, also with no apparent reason, in the middle of another
conversation
Stay attentive and be able to switch the conversation avoiding showing signs of surprise
or judgement
 Development of physical symptoms that do not have any clinical explanation
(headache, stomachache, muscles pain, chest pain…)
 STI’s in children, and repeated STI’s in women detected in gynecologist consultations
 Isolation, social exclusion, integration difficulties
 Absenteeism at work
Social Signs  Decreased productivity and skill at work
 Job Loss
 Decrease in joyful activities
 Lack of participation in social activities
 Vague, confused, changing explanations for the reasons for the consultation,
embarrassment vis-à-vis caregivers
 Explanations that cannot match the symptoms
 Hesitation to disclose the cause of the trauma
 Signs of self-mutilation, self-harm (especially in adolescents)
Psychological  Inhibition of personal power (feeling of helplessness and vulnerability, loss of control
or behavioral over life)
signs  Passivity, lack of initiative, difficulty making decisions for oneself.
 Numbness
 Regression behaviors (regression behaviors might manifest at all developmental stages
and age. Alert: secondary encopresis, secondary enuresis especially in older children
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 and adolescents
 Feelings of defeat, shame, aggressiveness ...
 Psychological and psychiatric disorders (fear, anxiety, sadness, depression, stress, self-
harm, suicidal thoughts or suicide attempts, post-traumatic stress disorder)

SECTION 6: LOOK & LISTEN

All health professionals working in PHCC need to LOOK & LISTEN to GBV survivors, including survivors of sexual violence.
Remember your role is believe the person and listen without judgment and to

Look
DO allow the survivor to approach you. Listen to their needs.
DO ask how you can support with any basic urgent needs first. Some survivors may need immediate medical
care, protection, clothing.
DO ask the survivor if s/he feels comfortable talking to you in a private location. If a survivor is accompanied
by someone, do not assume it is safe to talk to the survivor about their experience in front of that person.
DO provide practical support like offering water, a private place to sit, a tissue etc.
DO, to the best of your ability, ask the survivor to choose someone s/he feels comfortable with to translate
for and/or support them if needed.
DO NOT ignore someone who approaches you and shares that s/he has experienced something bad,
something uncomfortable, something wrong and/or violence.
DO NOT force help on people by being intrusive or pushy.
DO NOT overreact. Stay calm.
DO NOT pressure the survivor into sharing more information beyond what s/he feels comfortable sharing.
The details of what happened and by whom are not important or relevant to your role in listening and
providing information on available services.

Listen
DO treat any information shared with confidentiality. If you need to seek advice and guidance on how to best
support a survivor, ask for the survivor’s permission to talk to a specialist or colleague. Do so without
revealing the personal identifiers of the survivor.
DO manage any expectations on the limits of your confidentiality, if applicable in your context.
DO manage expectations on your role and avoid making promises on what you can do and possible
outcomes.
DO listen more than you speak.
DO believe what they are saying
DO say simple statements of comfort and support; reinforce that what happened to them was not their fault.
DO NOT take photos of the survivor, record the conversation on your phone or other device, or inform
others including the media.
DO NOT ask questions about what happened. Instead, listen and ask what you can do to support.
DO NOT make comparisons between the person’s experience and something that happened to another
person.
DO NOT say that the situation is “not a big deal” or unimportant. What matters is how the survivor feels
about their experience.
DO NOT doubt or contradict what the survivor tells you.
DO NOT judge her/his way of dealing with the situation or blame her/him for what happen.

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 PART III
APPLICATION OF REFERRAL PROCESS

SECTION 7: Referral process for health care provider (MdM MPHSS and PHCC staff)
Confidentiality and informed consent are the basis for any referral

Majority of GBV do not receive assistance and/or services5. The main reasons for the lack of access to services include
denial implementation of protection services were a) fear of revenge and punishment, b) fear of social stigma c) lack of
awareness about available services and d) concerns about breach of confidentiality.

As service providers working in a health facility, you are in a unique position to aid GBV survivors. Specialized services
are critical for the recovery and healing of GBV survivors and ensuring their safety and well-being throughout the
process. Your role is to facilitate their access to specialized care by referring them to a case manager or providing
information about key services. Your role is not to seek out GBV survivors visiting the health facility but to be responsive
when encountering a survivor during your regular work at the facility.

IF THERE IS AN IMMEDIATE RISK OF SAFETY OF THE SURVIVOR / IT IS A LIFE-THREATENING CONCERN ask the survivor
if you can contact directly the GBV Case Manager on her behalf.

Pathway to referral or services

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Step 1: Ask if she/he would like to be referred to GBV case manager. If yes, see step #2

If the answer is no,

Maintain confidentiality. Explain that the survivor may change his/her mind and may seek services at a later time. Let
them know that they can return to see you when they wish to do so. Do not pressure anyone into receiving assistance.
Ask them if they would like to know more information about other services available in the area. Refer to service
mapping. No form is required to be completed. In some instances, GBV survivors may not be ready to undertake a case
management process but need information about existing services that may contribute to her/his recovery such as legal
assistance, livelihoods or economic support, basic needs, or specialized mental health services.

Linked to services Provide information on GBV services: medical, legal, psychosocial, specialized care,
economic/livelihood, basic needs support, specialized care. Mention that while you keep your service mapping up to
date, it’s possible that facilities and organizations stop offering services on short notice including of case management
offered by other INGO/NGO. Explain the role of a case manager and how they can facilitate a survivors’ recovery process
by accompanying them while seeking an array of services. No intake form to be completed.

Information communicated should include the following:

 How to access it
 Relevant times and locations
 Focal points at the service
 Safe transport options.

Step 2: Explain the case management (referral).

 Case management is a structured method for providing help to a survivor. MdM’s GBV Supervisor will use a
comprehensive approach with multiple steps needs. (See below). The case manager will support the survivor in
receiving the care provided by different services using a survivor-centered approach while providing psycho-
social support. Case manager are skilled and experience professional with specialized training on GBV that will
treat survivors with dignity and will respect their wishes throughout out the process. Case management steps

Evaluation &
Engagement Assessment Planning Implementation Monitoring
discharged

Should the GBV survivor wish to be referred to YUW Case manager, you will need to complete the referral form
(See Annex I). Ensure that the form is signed by the person receiving the referral. Explain the measures that are
in place to keep the information she/he provides confidential such as locked cabinets, no need to provide
personal details, and the confidentially agreement signed by PHCC staff.

Explain the confidentiality measures taken during case management

- Consent forms if applicable
- Use of codes (no name)
- No home visits by case workers
- Documents are stored in a cabinet that locks
- Professional practice of ensuring confidentiality of GBV survivors

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PRIORITIZE URGENT HEALTH CARE IN OCCURRENCE OF SEXUAL VIOLENCE. With the informed consent of the survivor,
ensure immediate access to available medical care. The provision of lifesaving, timely and confidential health care to a
survivor is the priority.

In the context of Yemen, clinical management of rape (CMR) is conducted in hospitals and PHCC and offered by health
workers and treated like an ordinary case/patient due the lack of knowledge and capacity if health works ,where post-
rape care supplies were not supply for some time now and what every balance from last distribution is used by GPs up
to date, MdM is planning to procure PEP Kit suppliers in the coming phase of the project. lack of Protocol/Guideline of
Clinical Management of sexual assault survivors is the official protocol to standardize and harmonize CMR services in
both south and North.

Before providing information on where to receive specialized medical care for sexual violence,

Let the survivor know that medical assistance is cases of rape include the following services.
 Preparing the survivor for the examination
 First Aid Psychological support
 Taking History including screening questions for suspected cases
 Collecting Forensic evidence
 Performing General Physical examination
 Performing Genital Examination (inspection)
 Performing genital examination (internal)

REFERRAL FOR MALE GBV SURVIVORS

Follow the same referral pathway as above. Service providers must acknowledge that men (and boys) can be survivors
of gender-based violence, including of sexual violence, and have the same needs as any survivor—they need to feel safe,
cared for, believed, encouraged and assured that seeking help and/or acknowledging the violence they’ve experienced is
the right thing to do.
Consider the following recommendations:
 Build trust with patient: This entails active listening, believing the survivor’s story and using positive and
affirmative messages. Clearly convey that their case – should they choose to seek a case manager - will be
handled confidentially.
 Promote environment of inclusivity: Men and boys should know that services are responsive and sensitive to
their needs, that these services are available and welcoming for them.

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  Be aware of signs of sexual abuse against men and boys and educate patients about its effects: Often, male
survivors will not sit comfortably, complain of the back aches (which signals potential rectal problems), show
high levels of anger and homophobia, are unable to relate to other persons including family members, and will
withdraw from social or community activities.
 Acknowledge that sexual abuse against men and boys exists: In general, males, especially adolescent males, may
be much less likely to disclose and/or speak about their abuse experiences because being a survivor can be seen
as a countercultural experience.

REFERRAL FOR CASES OF VIOLENCE AGAINST CHILDREN (PERSONS UNDER 18).

CONTACT EMERGENCY CHILD PROTECTION SERVICES IF THE CHILD IS IN IMMEDIATE DANGER best interest of the child
should always be the primary consideration when taking actions on behalf of children.

Children are one of the most vulnerable groups in society and that all children have the right to be safe and protected.
Do not seek out child survivors because you do not have the required skills set to investigate suspected cases of a
child/adolescent experiencing exploitation, abuse, neglect and/or another form of violence. As general health
practitioners at a facility, it is assumed that you’ve not received specialized training. As such, your actions can potentially
lead to more violence and risks for the child/adolescent.

Specialized services for child protection are herewith understood as child protection caseworkers, as they will be able to
support the child in receiving the various services using specific skills. In many situations, children and families will need
support from more than one agency because of their varied needs. Therefore, caseworkers know which agencies are
child-friendly and how to provide the child and family members with complete information about the referral agencies
(including the potentially negative as well as positive consequences of the referral). This information is shared during the
discussion between the child and caseworker on their identified needs and existing options for help.

If a child/adolescent and/or a care provider with a child is seeking your help or if you’ve been made aware of a case of
child abuse, take action when it’s safe for the child by calling the nearest child protection services (case workers).
Unless specifically requested by the child/adolescent and/or the parent or guardian, you don’t offer information about
the available services. Contrary to procedures for adults whereby referring and linking services with a survivor is done by
providing information to the survivors, in instances of child protection, the specialized services are contacted by the
person suspecting the case.

All you need to provide is name of child and parent/caregiver and his location. No paper trace, and confidentially is of
the upmost importance.

SECTION 8: Documentation, monitoring and recording referral

1) Referral Form (see annexes I)

A hard copy of the referral forms is to be kept in the office of the MHPSS staff in the locked cabinet. On a monthly basis,
GBV case managers will collect the forms to archive in their office in a locked cabinet.

2) Monitoring referral
Each MHPSS staff that offers referral to GBV case managers is responsible to enter the information in the MHPSS Case
Management – internal Referral Tracker. At the end of each month, the GBV Supervisor will review then transfer the
data into the “Moni-tool”.

PART IV
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 IMPLEMENTATION AND REVIEW OF SOP

SECTION 10: Roles and responsibilities

The SOPS are intended for:

 PHCC management/Supervisors
 Medical staff in PHCC (MD, nurse, pharmacist, nutrition expert, etc)
 MdM staff working in PHCC (Social workers, MHPSS staff, counsellors, etc)
 MdM GBV Supervisors
 MdM GBV Coordinator

Roles and responsibilities

1) Ensure facility has secure storage for confidential documents and that only a
DoH / PHCC limited number of people have access to the storage.
Management 2) Disseminate SOP to staff and ensure available copies, including of service
mapping

1) Provide referral to GBV survivors as per these SOPs

Health care providers 2) Be familiar with the SOPs
3) Have a copy of the SOPs and up-to-date service mapping
1) Provide referral to GBV survivors as per these SOPs
2) Be familiar with the SOPs
MdM MHPSS Staff 3) Have a copy of the SOPs and up-to-date service mapping
4) Offer non-specialized counselling (individual & in group sessions) to GBV
survivors
1) Receive referral to start case management process
2) Link with MHPSS services
MdM GBV 3) Train and mentor PHCC and MdM staff on the SOPs.
Supervisors 4) Consolidate all forms related to referral and case management
5) Report on monthly basis
6) Update service mapping and inform teams of key updates
1) Provide on-going technical support
MdM officer 2) Conduct supervision mission
3) Review periodically SOP

MdM has a code of conduct and a zero-tolerance policy against acts of sexual abuse and/or exploitation.

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 ‫‪ANNEX I‬‬
‫‪Referral Form‬‬

‫‪:‬االستجابة الفورية إذا کانت‬

‫تاریخ االحالة‬
‫االولویةعلى مقدم الخدمة توفير بيئة آمنة‪ ،‬رعاية واحترام السرية ورغبات الناجي‬
‫• يجب‬
‫ساعة)للناجين من العنف القائم على النوع االجتماعي‬
‫‪٢٤‬والدعم‬‫المتوفرة‬
‫الخدمات خالل‬
‫عن المطلوبة‬ ‫موثوقة وشاملة‬
‫(االجراءات‬ ‫معلومات‬
‫الخطورة ‪١‬‬ ‫•☐توفير‬
‫مستوى‬
‫ساعة)وقم باإلحاالت‬
‫المستنيرة‬
‫الموافقة ‪٧٢‬‬ ‫احصل على‬
‫المطلوبة خالل‬ ‫وطلبت ذلك ‪،‬‬
‫(االجراءات‬ ‫مستوىالناجي‬
‫الخطورة ‪٢‬‬ ‫•☐إذا وافق‬
‫من إعطاء األولوية لمصلحة الطفل الفضلى‪ .‬ويفضل أن يختار الطفل الشخص البالغ المرافق‬ ‫تأكد‬ ‫‪،‬‬ ‫الطفل‬ ‫عن‬ ‫نيابة‬ ‫األوصياء‬ ‫‪/‬‬ ‫األسرة‬ ‫تقرر‬
‫مستوى الخطورة ‪( ٣‬االجراءات المطلوبة خالل ‪ ٧‬ایام)‬ ‫•☐عندما‬
‫معه‪.‬‬
‫• بالنسبة للناجي من االغتصاب ‪ ،‬ضمان الحصول الفوري على الرعاية الطبية (في غضون ‪٧٢‬ساعة)‬
‫االحالة عن طریق‪:‬‬ ‫االحالة الی‪:‬‬
‫موقع مرکز الرعاية الصحية األولية‪:‬‬ ‫☐ مدير حالة لعنف القائم على النوع االجتماعي‬
‫اسم الموظف‪:‬‬
‫منصب الموظف‪:‬‬
‫هاتف‪:‬‬
‫البريد إالكتروني‪:‬‬

‫معلومات الناجي (جميع المعلومات الشخصية اختيارية حسب المستوى الذي يوافق العميل على الكشف عنه‪ -‬اختياري )‬
‫إذا لم يكشف الناجي عن االسم والمعلومات الشخصية األخرى ‪ ،‬قم بتقديم مرجع او تابع الرمز )‬
‫االسم او رقم المرجع‪:‬‬
‫العنوان‪:‬‬
‫الهاتف‪:‬‬
‫تاريخ الميالد‪:‬‬
‫الجنس‪:‬‬
‫‪:‬‬

‫إذا كان الناجي طفل (أقل من ‪ ١٨‬عاًم ا)‬

‫اسم مقدم الرعاية الرئیسي‪:‬‬

‫العالقة بالطفل‪:‬‬

‫معلومات االتصال بمقدم الرعاية‪:‬‬

‫تم إبالغ مقدم الرعاية باإلحالة؟ ☐ نعم ☐ ال (إذا كانت اإلجابة ال ‪ ،‬اشرح ذلك) ______________________‬

‫‪15‬‬
 ‫معلومات أساسية ‪ /‬سبب اإلحالة (وصف المشكلة ‪ ،‬الفترة ‪ ،‬التكرار الخ‪ .‬فقط المتعلقة باإلحالة)‬

‫الخدمات التي قدمت ‪( :‬من ضمنها أي إحاالت أخرى تم إجراؤها ‪ -‬فقط المعلومات ذات الصلة باإلحالة )‬

‫التاریخ‬ ‫المساعدة‬ ‫الجهة‬

‫االحتياجات اإلضافية الخاصة للناجي‬

‫امراءة‬ ‫طفل‬
‫☐ حامل‬ ‫☐ الطفل ال يذهب إلى المدرسة‬
‫☐ ربة منزل‬ ‫☐ مراهقة حاملة‬
‫☐ امرأة معاقة‬ ‫☐ طفل زوجة‬
‫☐ امرأة نازحة‬ ‫☐ أم طفلة‬
‫☐ امرأة عائدة‬ ‫☐ األطفال المتورطون في عمالة األطفال‬
‫☐ األطفال غير المصحوبين ‪ /‬المنفصلين عن ذويهم‬
‫قدم شرًحا إضافًيا هنا‪:‬‬ ‫☐ طفل معاق‬
‫الرجل‬

‫☐بدون عمل‬
‫☐ يعيش مع معاق‬
‫☐ رجل معاقة‬
‫☐ يعين اكثر من ‪ 10‬شخص‬
‫☐ سنوات النزوح اذا اكثر من ‪ 2‬سنوات‬

‫الموافقة على اإلفصاح عن المعلومات (اقرأ مع الناجي وأجب عن أي سؤال قبل أن يوقع أدناه)‬
‫أنا ‪ ، _________________________________________________________ ،‬أفهم أن الغرض من اإلحالة واإلفصاح عن هذه‬
‫المعلومات‬
‫‪16‬‬
 ‫لـ ____________________________ هو ضمان سالمة واستمرارية الرعاية بين مقدمي الخدمة الذين يسعون إلى خدمة هذه األسرة ‪/‬‬
‫الشخص‪ .‬لقد أوضح مزود الخدمة ‪ ، ________________________________________ ،‬بوضوح إجراء اإلحالة لي وأدرج المعلومات‬
‫الدقيقة التي سيتم الكشف عنها‪.‬‬
‫من خالل التوقيع على هذا النموذج ‪ ،‬أصرح بتبادل المعلومات هذا‪.‬‬
‫التاریخ‪:‬‬ ‫توقيع الناجي (الوصي إذا > ‪:)١٨‬‬

‫توقيع موظف اطباء لعالم‪::‬‬

‫الوكالة المستلمة‪:‬‬
‫تلقى اإلحالة من‪:‬‬
‫التاريخ‪:‬‬
‫‪:‬الوقت‬

‫‪ANNEX II‬‬
‫‪Dos and don’ts for non-GBV actors to interact with GBV survivor‬‬

‫‪17‬‬
Key dos and don’ts when engaging with a GBV survivor
DO respect the rights of the survivor to make their own decisions.
DO share information on all services that may be available, even if not GBV specialized services.
DO tell the survivor that s/he does not have to make any decisions now, s/he can change their mind and
access these services in the future.
DO ask if there is someone, a friend, family member, caregiver or anyone else who the survivor trusts to go
to for support.
DO offer your phone or communication device, if you feel safe doing so, to the survivor to contact someone
s/he trusts.
DO ask for permission from the survivor before taking any action.
DO end the conversation supportively
DO NOT exaggerate your skills, make false promises or provide false information.
DO NOT offer your own advice or opinion on the best course of action or what to do next.
DO NOT assume you know what someone wants or needs. Some actions may put someone at further risk of
stigma, retaliation, or harm.
DO NOT make assumptions about someone or their experiences, and do not discriminate for any reason
including age, marital status, disability, religion, ethnicity, class, sexual orientation, gender identity, identity
of the perpetrator(s) etc.
DO NOT try to make peace, reconcile or resolve the situation between someone who experienced GBV and
anyone else (such as the perpetrator, or any third person such as a family member, community committee
member, community leader etc.)
DO NOT share the details of the incident and personal identifiers of the survivor with anyone. This includes
the survivor’s family members, police/security forces, community leaders, colleagues, supervisors, etc.
Sharing this information can lead to more harm for the survivor.
DO NOT ask about or contact the survivor after you end the conversation.

18